ponding at the heart of the most-affected regions – south-central Somalia. Unable to establish a clear diagnosis of the situation, aid organizations base their calls for public support primarily on extrapolations that rely on limited, fragmented and, often, outside interventions that risk distorting reality, minimizing difficulties of access and over-estimating the effectiveness of aid.

Amisom forces in Somalia have called for an additional 3,000 troops to strengthen security in the neighborhoods and assist displaced populations in the capital following the departure of Islamist groups. The Transitional Federal Government (TFG) has offered amnesty to Shabab militants in Mogadishu who are ready to lay down their arms. Following these statements, which have won hearts and minds, NGOs are now rushing to enter the capital – accepting that their presence may be politically exploited – in order to assist the 100,000 people who, according to UN estimates, have arrived in the capital in recent months.

However, Mogadishu is hardly a sanctuary today. The TFG lacks legitimacy and does not represent all interests. In addition, the city is wracked by divisions, shifting alliances and rivalries among the clans dominating the neighborhoods. The tensions arising from the stakes associated with humanitarian aid have heightened, while the tactical retreat of the Shabab militants could increase the risk of attack, assassination and other forms of violence. According to several sources, it seems that TFG soldiers were responsible for the looting and gunfire that led to the death of several civilians. Given the insecurity, there are limited opportunities to move around, evaluate the situation or take action and the presence of expatriate staff remains restricted. Negotiations that would allow aid staff to work effectively in population resettlement areas are often long and difficult. The date, nature and scale of interventions depend as much on the talks and conditions for obtaining access to the many displaced persons’ camps as on the nature of the emergency. Furthermore, multiple medical priorities complicate matters: vaccinating a specific age group against measles requires a different operational and security system than does installing water supply or conducting a general food distribution.

Outsde the capital, it is impossible to ensure the ongoing presence of expatriates. For the moment, few NGOs can reach other areas controlled by the armed opposition. MSF was only able to obtain approval to operate approximately 10 programs throughout south-central Somalis after difficult negotiations at the local level, but these programs are now finding it difficult to expand and diversify. While our Somali teams’ ability to conduct an analysis is limited in Mogadishu, outside the city the teams’ analysis is even further restricted, focusing primarily on the work carried out in our regular programs. For now, we have not been successful in negotiating an expansion of our activities, despite troubling signs in terms of nutrition, measles and diarrheal illnesses. Most of the other aid organizations have been refused access, as they are suspected of spying for the West, attempting to destabilize the local economy or proselytizing. Thus, what separates many NGOs from the Shabab, the elders and other “military-political” business leaders – the “warlords” – currently seems greater than concerns they may have in common. For now, humanitarian aid organizations and local representatives cannot find common ground: improving the condition of the population.

Somalia has been in conflict for 20 years. This failed state is home to one of the most fully-realized forms of free enterprise. Despite the clan structure, the social structure has become privatized and disunited, responding, first and foremost, as a collection of private interests, rather than on the basis of the overall public interest. “Emergency” is thus only a theoretical notion that extends, in practice, for as long as the negotiations with all the parties involved in aid continue.

The discussions and the political stakes associated with aid require adopting a different sense of time, which is frustrating for MSF and incompatible with the media’s timeframe. Waiting, negotiating and compromising at the risk of agreeing to turn a partial blind eye — that is the price we pay. But for now, that cost does not justify abandoning a mission to aid a war-ravaged population. MSF has been asking this question continuously over our 30 years of work in Somalia. So far, we have chosen to continue.

In Somalia, as elsewhere, good intentions are not enough. Humanitarian action involves compromise but must never lead to a compromise of principles. If we promise that aid will never be exploited or partially diverted by the present forces, we forget that certain practices exist which sometimes constitute the only way to obtain recourse to assistance. Where do we draw the line? That is the question we face. Between theft, extortion, diversion for political ends, payment of “tolls” and demands that we hire armed guards or contribute to the war effort, we also face an enormous range of risks and pitfalls, requiring that we make a choice, over and over again: accept or renounce.